It’s 10 a.m. on a recent Tuesday morning, and the waiting room at Riverside Medical Clinic in Turtleford is empty. “I’ve had people comment that we must not be very busy,” said medical office assistant Patsy Olson. “But we have all four doctors seeing patients all day today!”

Seven months ago, the waiting room would likely have been overflowing with patients by 10 a.m., and staff would have been managing without enough space. But in October 2014, the clinic team took part in a Rapid Process Improvement Workshop (RPIW) that studied and improved patient flow in the clinic.

The RPIW team was made up of clinic staff, Prairie North Health Region staff, a physician, and a patient. They identified problems with the patient flow right away: individual patient exam rooms were set up for specific physicians only, and there never seemed to be enough patient exam rooms. Patients had to have their vital signs taken in the hallway then would return to the waiting room until the physician was able to see them. There was a lack of privacy, and too many opportunities for mistakes and mix-ups.

Dr. Mzikayise Tshatshela said the five days he spent working on the RPIW team were well worth the time. “It was an opportunity to just step back and observe,” he explained.

“When you are doing your daily routine, you don’t have time to reflect and see what’s not going right and see what the frustrations are, be it for patients, front staff, or physicians.”
(Dr. Tshatshela)

The RPIW team came up with and tried a number of different ideas to improve patient and provider flow. Significant changes were made: physicians and other care providers agreed to share office space, freeing up two rooms to be converted to patient exam rooms; exam rooms were standardized so that all physicians and care providers could use any room knowing the right supplies would be in the right place to provide care; and computers in each room were wall mounted on swiveling stands, allowing care providers to maintain eye contact with a patient while reviewing information or updating the electronic medical record.

“Our rooms are so good now, a great improvement,” said Dr. Tshatshela.

The result of these improvements is that patients are now placed directly in an exam room to have their vitals taken and then stay in that room until the care provider arrives to see them. With more exam rooms available, patients don’t need to be shuffled around, and physicians are no longer rooming patients themselves. Sharon Drewlo was the patient representative on the RPIW team. “I am amazed at what has been achieved in such a short period of time,” she said at the end of the event week.

Clinic staff always worked hard to serve patients and help physicians provide the best possible care. Medical office assistant Janet Cadrain says they just didn’t have time to think about what changes could be made. An RPIW creates that time and space to trial improvements.

The RPIW was challenging, Cadrain said. “But once things got going, it was awesome.” Improvements continue to be made, too. “We discuss in our huddles in the morning if things aren’t going right, or if we think something in our processes can be tweaked. It’s worked really, really well. Little changes can make a big difference,” she added.

“We discuss in our huddles in the morning if things aren’t going right, or if we think something in our processes can be tweaked.” (Janet Cadrain, medical office assistant)

Pat Guenther is administrator for North Saskatchewan River Municipal Health Holdings, which operates the medical clinics in Turtleford, Edam, St. Walburg, and Glaslyn. She admits she was a little skeptical when she first heard an RPIW would be held at Riverside. “I’d taken some lean training and I wasn’t sure how it would affect us in a positive manner. But as the process went through, we saw good buy-in by the staff and the physicians, and I definitely was impressed with the outcome.”

About Prairie North Health Region

Prairie North Health Region is located in northwest central Saskatchewan, and encompasses the cities of North Battleford, Meadow Lake, and the SK/AB border city of Lloydminster. PNHR provides a comprehensive network of health services to its more than 78,000 Saskatchewan residents and over 18,000 people who live on the Alberta side of Lloydminster.

PNHR is unquestionably unique: it is the only Saskatchewan health region with two Regional hospitals (Battlefords Union and Lloydminster); is home to the province’s only psychiatric rehabilitation hospital (Saskatchewan Hospital North Battleford) and the province’s Forensic Services program. PNHR is the only Saskatchewan health region that has direct responsibility for Alberta residents.

About Better

Technology is the way of the future in medicine and I think this would help everybody – physicians as well as patients!

Dr. Rossouw, Physician, Regina Qu'Appelle

I was encouraged by the electronic concept of providing documentation in the Emergency Department. As a patient advisor, it was a positive experience to work with actual patients to receive patient input and opinions into this process.

Bev Greenfield, patient, Regina Qu'Appelle

This will save us a lot of time spent searching for equipment so that we can focus more on patient care.

Amanda Dela Cruz , LPN, Regina Qu'Appelle

Ordering supplies is logical and simplified…. (This project) will prevent an abundance of supplies that are not used, (resulting in) cost savings.

Shawn Duddridge , RN, Prairie North

I was excited to be part of a much needed project. It was great to see Emergency Department physician engagement. This will be a great improvement for patient care!

Shona Lafreniere Health Records Staff, Regina Qu'Appelle

Looking forward to saving steps and freeing up some time for Resident interaction. Good to be able to document interactions

Connie Redekop, CCA, Cypress

The passion targeted to quality care for our patients demonstrated during this RPIW will lead to great results.

Kevin Kozan, patient, Regina Qu'Appelle

The addition of a mobile stock/linen cart for the CCA’s with adequate stock greatly reduces lost time and steps. Go Team! By adding this time back to their day it can be used for prompt documentation and quality interactions with Residents.

Seccora Mazur, CCA, Cypress

With now having questions to ask, there can be more one on one interactions. With the introduction of the white boards in the room, I can see what is going on as a family member and also see what they need.

Cathy Nault, patient, Cypress

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